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Click ‘Get Form’ to open it in the editor.
Begin by entering today's date in the specified format (mm/dd/yyyy) at the top of the form.
Indicate whether this was a significant event by selecting 'Yes' or 'No'.
Fill in the date and time of the event, ensuring accuracy for proper reporting.
Provide the full name and address of the facility, including city, state, and zip code.
Complete the section on type of incident by checking all applicable boxes that describe the event.
If applicable, answer questions regarding notifications made to law enforcement or other authorities.
For allegations of abuse or neglect, complete the Alleged Perpetrator Information Section thoroughly.
In the narrative section, describe the event in detail, including any relevant background information and interventions taken post-event.

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Which is an example of a reportable incident?

A fatality, inpatient hospitalization, amputation, or loss of an eye is considered a serious workplace incident that must be reported directly to OSHAby phone or onlineusually within hours. A business must notify OSHA of any fatality within eight hours of the death.

What are reportable incidents in assisted living in Arizona?

Intentional infliction of physical harm, injury caused by negligent acts or omissions, unreasonable confinement, and sexual abuse or sexual assault as specified in A.R.S. 46- 451(A)(1).

Which is considered a reportable event?

Unanticipated Problem Involving Risk to Human Subjects or Others: Any accident, experience, new information or outcome that meets all of the following criteria: Unexpected in terms of nature, severity, or frequency; Related, or possibly related, to research activities; and.

What are the mandatory reporting requirements in Arizona?

That means if a child tells you about abuse, sexual abuse, or neglect, you are required to call a law enforcement (police) agency, the Arizona Department of Child Safety (DCS) or a Tribal police or social services agency. Parents are mandatory reporters.

arizona department of health services regulations

Arizona Department of Health Services regulations AZ dept of Health Azdhs reporting Arizona Department of mental health Arizona Department of Health Services immunization records Arizona Department of Social Services Arizona Food Health Department Tucson Health Department